Mutations and sequence variants in GDF9 and BMP15 in patients with premature ovarian failure
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European Journal of Endocrinology (2006) 154 739–744 ISSN 0804-4643 CLINICAL STUDY Mutations and sequence variants in GDF9 and BMP15 in patients with premature ovarian failure Paul Laissue, Sophie Christin-Maitre1, Philippe Touraine2, Frederique Kuttenn2, Olli Ritvos3, Kristiina Aittomaki4, Nathalie Bourcigaux1, Laetitia Jacquesson1, Philippe Bouchard1, Rene Frydman5, Didier Dewailly6, Anne-Céline Reyss6, Luke Jeffery3, Anne Bachelot2, Nathalie Massin7, Marc Fellous and Reiner A Veitia INSERM 709, Genomics and Epigenetics of Placentary Pathology, Hôpital Cochin, Pavillon Baudelocque, 123 Bd de Port Royal, 75014, Paris, France, 1 Reproductive Endocrine Unit, Hôpital Saint-Antoine, Faculté Pierre et Marie Curie, UPRESS 1533, 75012 Paris, France, 2Faculty of Medicine, Université Paris V, Necker Hospital, APHP, 149 rue de Sèvres, 75743 Paris cedex 15, France, 3Program of Developmental and Reproductive Biology, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland, 4Department of Clinical Genetics, Helsinki University Hospital, Helsinki, Finland, 5 Department of Gynaecology and Obstetrics, Hôpital Antoine Béclère, 92141, Clamart cedex, France, 6Department of Endocrine Gynaecology and Reproductive Medicine, Hôpital Jeanne de Flandre, CHRU, 59037, Lille, France, and 7Department of Gynaecology and Obstetrics, Reproductive Unit, Intercommunal Hospital, 94110 Creteil, France (Correspondence should be addressed to R A Veitia; Email: veitia@cochin.inserm.fr) Abstract Background and objective: Mutations in bone morphogenic protein 15 (BMP15) and growth/differen- tiation factor 9 (GDF9) lead to altered fertility in animal models. In the human, a heterozygous point mutation of BMP15 has been associated with premature ovarian failure (POF). Subject and methods: We have directly sequenced both genes in a cohort of 203 POF patients present- ing with primary or secondary amenorrhea and high FSH levels and in a control population including 54 women with regular menstrual cycles who had at least one child. Results: We have identified several heterozygous variants. One alteration in GDF9 (S186Y) and one in BMP15 (L148P) may have pathogenic effects as both positions are conserved in vertebrate species, ranging from the chicken to mammals. These variants were absent in the control samples. We also found synonymous and neutral substitutions. Conclusions: We propose that although mutations in BMP15 and GDF9 are not a major cause of ovar- ian insufficiency, they may be involved in POF. European Journal of Endocrinology 154 739–744 Introduction Mutations in bone morphogenic protein 15 (BMP15) and its close autosomal paralogue growth/differentia- Premature ovarian failure (POF) is defined as amenor- tion factor 9 (GDF9) are able to alter female sheep rhea for at least 6 months occurring before the age of and mice fertility (12 – 15). Recently, a point mutation 40 years, associated with raised plasma gonadotrophin in BMP15 has been associated with POF (16). A 4 bp levels (follicle-stimulating hormone (FSH) greater than deletion of GDF9 apparently leading to a premature 40 mIU/ml) (1). POF has a prevalence of 1%. Ovarian stop codon has been reported in two sisters with failure can result from viral or auto-immune oophoritis, twins from one family (17). Furthermore, two missense environmental toxins and iatrogenic causes such as mutations in GDF9 have recently been associated with pelvic surgery, radiation or chemotherapy. Deletions POF (18). BMP15 and GDF9 (respectively located on and translocations involving three extensive regions Xp11.2 and 5q31.1) encode soluble factors, which of the X chromosome (i.e. Xq13–22, Xq26 –28 and belong to the transforming growth factor superfamily Xp11.2 –22.1) have been associated with POF (2 – 5). (TGFb). TGFb proteins are involved in various develop- In Turner’s syndrome, ovarian insufficiency is probably mental processes including reproductive functions due to haploinsufficiency of pseudoautosomal loci of (19 – 21). In mammals, BMP15 and GDF9 are specifi- the X chromosome (6, 7). Mutations in autosomal cally expressed in the oocytes in a similar spatio-tem- genes (i.e FSHR, FOXL2, GALT) have also been related poral pattern throughout folliculogenesis (20, 22 –24). to POF (8 – 11). Nevertheless, in most cases the etio- Both genes have two exons and encode prepropro- pathology of the disease remains unknown. teins composed of a signal peptide, a proregion and a q 2006 Society of the European Journal of Endocrinology DOI: 10.1530/eje.1.02135 Online version via www.eje-online.org Downloaded from Bioscientifica.com at 01/08/2021 06:52:17AM via free access
740 P Laissue and others EUROPEAN JOURNAL OF ENDOCRINOLOGY (2006) 154 mature peptide. The signal peptide region is encoded by tux.embl-heidelberg.de/ramensky/index.shtml). The the first exon, the proregion by segments of both exons SIFT software uses the protein sequence similarity of and the mature peptide region by the second exon. different species and the hydrophobic characteristics Their biological activity depends on the formation of of amino acids to calculate the probability of a deleter- homo and/or heterodimers after proteolytic processing ious effect of specific amino acid variants (28). Scores (25– 27). lower than 0.05 suggest a potential pathogenic Here we have screened a cohort of 203 POF patients amino acid substitution. The PolyPhen program offers for mutations in GDF9 and BMP15. We analyzed the information about the effect of the amino acid substi- entire coding sequences of both genes by direct sequen- tution by considering structural parameters and cing. The variants were screened in a panel of 54 three-dimensional protein structures (29, 30). The women with normal fertility. GoCore program version 5.0.1 (http://www.helsinki. fi/project/ritvos/GoCore/) was used for performing mul- tiple alignments of sequences from several vertebrate Materials and methods species including H. sapiens, P. troglodytes, C. familiaris, Patients and control population R. norvegicus, M. musculus, S. scrofa, B. taurus, C. hircus, C. elaphus, O. aries, T. vulpecula, D. novemcinctus, O. gar- Women (203 subjects) were recruited from several netti, M. mulatta, P. anubis, C. jacchus, M. domestica, G. clinical centres: Reproductive Endocrine Units from gallus and F. rupribes. Hôpital Saint-Antoine, Hôpital Necker, Paris, France, Hôpital Jeanne de Flandres, Lille, France, a gynaecolo- gical unit in Hôpital Antoine Béclère, Clamart, France Results and the the Department of Obstetrics and Gynaecology Sequence analysis of Helsinki University Hospital, Helsinki, Finland. Inclusion criteria were primary or secondary amenor- The analysis of the coding sequence of GDF9 revealed, rhea occurring before the age of 40 years, with an in one case, a heterozygous transversion 557C . A FSH serum level higher than 40mIU/ml. The group of (second exon). This leads to the change S186Y in the patients was composed of 83% of women of Caucasian proregion. This variant was not found in any control origin, 14.9% of African origin and 2.1% of Asian (n ¼ 54). Furthermore, we found two rather common origin (37 patients were Finnish). This study was synonymous substitutions, 447C . T and 546G . A approved by the institutional review board of the rel- (summary in Table 1). evant hospitals and all participants gave their written We detected, in the first exon of BMP15, a heterozy- informed consent. The control population included 54 gous transition G308A (with respect to the sequence women with regular menstrual cycles (28 – 32 days), AH007120 in Genbank). This variant appeared in having at least one child and no personal history of 99% of the patients and controls. In the second exon, infertility or auto-immune disease. Among these six different variants were detected. In one patient, we women 40 were of Caucasian origin and 14 of African found the heterozygous 443T . C transition, leading origin. to an L148P change in the proregion. We did not find this variant in any control (n ¼ 54). Furthermore, this patient presented an insertion of three base pairs DNA extraction and sequencing (788insTCT) leading to the insertion of a leucine at pos- Genomic DNA was isolated from whole blood samples ition 263. Ins263L was found in nine other patients using the standard phenol – chloroform procedure. and in 16.6% (nine of 54) of the control sample. All Both exons of GDF9 and BMP15 were amplified by the controls presenting these variants were of African PCR in all the patients (n ¼ 203). The second exon origin. Among the patients showing this mutation was amplified in all control individuals (n ¼ 54). PCR 60% were of African origin. A transition 588G . A products were treated with shrimp alkaline phospha- (A180T) was found in two patients at the heterozygous tase and exonuclease I as described by the manufac- state. This variant was not present in any control. In turer (USB, Cleveland, Ohio, USA) and directly addition, we detected three silent substitutions, sequenced using an ABI 3100 sequencer (Applied Bio- 538G . A, 831T . C and 468G . A (Table 1). systems, Foster City, CA, USA). The presence of each variant was confirmed by a new round of PCR amplifi- Patients’ phenotype cation and sequencing. BMP15-L148P The patient was a 30-year-old Afri- can woman presenting with secondary amenorrhea. In silico analysis She was a second daughter of a non-consanguineous To determine the potential deleterious effect of the family. Puberty occurred when she was 13 years amino acid changes we used SIFT (http://blocks.fhcrc. old, with normal secondary sex characteristics org/sift/SIFT.html) and PolyPhen softwares (http:// and breast development. The patient described initial www.eje-online.org Downloaded from Bioscientifica.com at 01/08/2021 06:52:17AM via free access
EUROPEAN JOURNAL OF ENDOCRINOLOGY (2006) 154 Mutations and sequence variants in GDF9 and BMP15 in POF 741 Table 1 Results of the sequence analysis of BMP15 and GDF9 in 203 POF patients. The overview includes base substitutions at the genomic level (numbering refers to the coding region), amino acid (AA) change, number of patients tested and allele frequency of each variant. Gene Sequence variation AA change Clinical information No. of patients Frequency in population BMP15 788insTCT Ins263L POF 203 4.93% (10/203) Controls 54 16.6% (9/54) 443T . C L148P POF 203 0.49% (1/203) Controls 54 0% (0/54) 538G . A A180T POF 203 0.98% (2/203) Controls 54 0% (0/54) 852C . T S284S POF 203 1.97% (4/203) Controls 54 0% (0/54) 831T . C T277T POF 203 0.49% (1/203) Controls 54 0% (0/54) 468G . A V156V POF 203 0.49% (1/203) Controls 54 0% (0/54) GDF9 557C . A S186Y POF 203 0.49% (1/203) Controls 54 0% (0/54) 447C . T T149T POF 203 75.9%(154/203) Controls 54 55.5% (30/54) 546G . A E182E POF 203 23.15% (47/203) Controls 54 26% (14/54) oligomenorrhea. When she was 19 years old, she family. At the age of 35 years, a coelioscopy was per- received the oral contraceptive pill (OC) until she formed showing atrophy of both ovaries. The ovary was 29 years old but she stopped it frequently. She cortex biopsy was composed of interlacing bundles of then became pregnant twice but interrupted the stromal spindle cells and contained some white body pregnancy in both cases. When she definitely stopped remnants but there were no follicles on serial sections. taking the OC, secondary amenorrhea appeared. After the initial diagnosis of POF, the patient received When she was referred to our department, the hormone replacement therapy. We did not have patient’s height was 163 cm and her weight was access to familial blood samples. 73 kg. Plasma FSH and luteinizing hormone (LH) were high: 120 mIU/l (normal (N), 4– 8 mIU/l) and 100 mIU/l (N, 3 –12 mIU/l) respectively. Plasma oes- tradiol and inhibin B were low: 30 pmol/l (N, 70 – Discussion 1000 pmol/l) and 15 pg/ml (N, 60 – 120 pg/ml) BMP15 and GDF9 play a key role in the molecular dia- respectively. No anti-thyroid or anti-ovary antibodies logue between the oocyte and the surrounding somatic could be detected. The karyotype was normal. cells, promoting granulosa cell mitosis and cumulus Pelvic ultrasonography showed a small uterus expansion by a paracrine effect (31, 32). They are syn- (68 £ 39 £ 27 mm), an atrophic endometrium and thesized as propreproteins composed of a signal peptide, very small ovaries in their surface (0.56 and a proregion and a mature peptide. As for many TGFb 0.64 cm2 for the right and left ovaries respectively factors, the proregion of BMP15 and GDF9 might be (N, 2– 6 cm2). No follicle was observed. The patient necessary for a correct folding, dimerization and received an oral oestrogen-progestagen treatment. secretion of the mature protein (19). In vivo, the biologi- We did not have access to blood samples from any cal role of BMP15 and GDF9 in animal fertility has family members. been demonstrated in mice and ruminants. Naturally occurring heterozygous mutations in BMP15 and GDF9-S186Y The patient, of Caucasian origin, was GDF9 in sheep increase the ovulation quota leading referred to us at the age of 37 years for primary infer- to hyperfertility, whereas homozygous mutations pro- tility. Menarche had occurred at 9.5 years of age with duce infertile animals (12, 13). The biological effect of regular menstrual cycles every 21 days up to the age the mutations in mammals varies among species (12, of 33 years, then her menses suddenly stopped. At 15). For example, GDF9 2/2 mice present a phenotype that time, her FSH, LH and oestradiol serum levels that is similar to BMP15 homozygous sheep mutants were respectively 104 mIU/ml, 46 mIU/ml and whereas BMP15 knockout (KO) mice have normal , 20 pg/ml. Anti-thyroid and anti-DNA serum anti- ovaries and subfertility (15). The double gene KO bodies were undetectable. No familial or personal his- leads to infertility while other combinations of alleles tory of pelvic surgery was recorded. Her height was display different phenotypes (15). The difference in 153 cm and her weight 60 kg. Her karyotype was the effects of the mutations could be explained 46XX. No other case of POF was identified in the by the intrinsic characteristics of mono-ovulatory or www.eje-online.org Downloaded from Bioscientifica.com at 01/08/2021 06:52:17AM via free access
742 P Laissue and others EUROPEAN JOURNAL OF ENDOCRINOLOGY (2006) 154 polyovulatory species. Moreover, the mutations in mice polymorphisms, 447C . T and 546G . A, in 154 are loss-of-function whereas in sheep and human there (75.9%) and 47 (23.1%) respectively of our POF are presumed to be dominant negative. Indeed, in vitro patients. These variants are common polymorphisms cell transfection assays using constructs corresponding in diverse ethnical groups since they have also been to the natural mutations observed in sheep demon- described in Indian POF patients (18). strated that dominant negative interactions between The sequence analysis of BMP15 revealed that the these factors have an important effect on the secretion heterozygous transition G308A (S103N, with respect of the mature peptides (27). In the human, a heterozy- to Genbank AH007120) that appeared in the first gous point mutation of BMP15 that has been associ- exon is in fact the most common allele. One patient car- ated with POF (Y235C) is located in the proregion ried a 443T . C transition at a heterozygous state in and in vitro experiments have shown a diminished the second exon. This leads to a L148P change at the stimulatory activity of granulosa cell mitosis by a protein level. This mutation was located in the prore- potential dominant negative effect (16). Recently, two gion, closer to the N-terminus than that described by missense mutations (K67E and V216M) located in Di Pasquale et al. (16). The ovarian phenotype of the the GDF9 proregion have been described in Indian patient with the BMP15 mutation was less severe POF patients and could be implicated in the ovarian than in the two cases previously described (16). A mul- phenotype (18). Sequence alignments have shown tiple sequence alignment showed that the amino acid that the first variant is not likely to have any functional L148P position was also conserved across vertebrates, relevance since in the sheep and the chicken the K resi- from chicken to mammals, suggesting a crucial func- due is replaced by an E. In the second case, the amino tional or structural role. As expected, both Polyphen acid V is well conserved or replaced by a highly hydro- and SIFT programs suggested a potential deleterious phobic residue which argues in favour of a functional effect. The substitution L-to-P translates into an impact. The results using SIFT are in agreement. important change in hydrophobicity (L . P) and rel- In our cohort of 203 patients, we identified two novel evant modifications in terms of structure. The presence heterozygous missense mutations, one in each gene, of a P might change the rigidity of the peptidic chain that could be implicated in the ovarian phenotype. and could alter protein folding itself or its kinetics. Sequencing of GDF9 revealed the mutation S186Y The mutation A180T, found in two patients, is not found in one patient with secondary amenorrhea. likely to be deleterious as suggested by the SIFT and Poly- The absence of this variant in women with normal Phen programs. Although we did not find it in any con- fertility suggests a potential pathogenic effect. This trol, the Thr appears in wild-type sequences from C. was further corroborated by the evolutionary conserva- hircus and O. aries. The insertion of a leucine in position tion of the S186Y in 17 vertebrate species, ranging 263, found in ten patients, probably has a low biological from chickens to mammals (Fig. 1). Accordingly, impact, as suggested by its presence in 16.6% of the con- both the SIFT (score ¼ 0.03) and PolyPhen predictions trols (nine of 54). Furthermore, it is present in rodents suggested a deleterious effect. We also found two and the marsupial T. vulpecula (Fig. 1). It is interesting Figure 1 Multiple protein sequence align- ments of BMP15 and GDF9 between mam- malian species displaying the regions of the second exon surrounding human mutations. Residues that differ from the wild-type (WT) human sequence are shaded in gray. Mutations found in the study are shaded in black. Dotted boxes highlight the positions of each variant. www.eje-online.org Downloaded from Bioscientifica.com at 01/08/2021 06:52:17AM via free access
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